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Re: Help needed - nipple and breast pain

Well, if the pain is resolving, I think that would be an indication there is no infection, or it has cleared up. I understand you are using a nipple sheild but, at least with thrush, isn't the nipple pain usually present even when baby is not nursing? That was my understanding?

No harm in continuing to use APNO as long as it is healing, since that has both anti fungal and antibiotic in it. As far as the nystatin suspension, I think its fine to have baby take that while you are treated with fluconazole, but according to BAMS it's much less effective than fluconazole. So if you suspect thrush again, maybe try to have baby prescribed a fluconazole suspension. Many moms do not like treating thier babies but if it is thrush it is unfortunately neccesary to treat baby as well. Remember that continuing to be able to breastfeed has so many health benefits it is worth it to get proper treatment for both of you when something is interfering with your comfort when nursing.

I am curious, does the blister appear white, (consistent with a bleb) or as if it is more clear (like a friction blister would look?)

It may be a good idea to see your LC again and have her observe a nursing session to see if there is anything you might be able to do differently in terms of postitioning or latch to help prevent more of these ,particularly if it being caused more by friction than a plug?

Thrush can get in the breast (it did for me, or at least, that's what I thought it was, and it seemed to respond to treatment?) where it can cause burning shooting pains at letdown. Not fun. ETA: Reading Meg's description that this is usually Raynaud's or bacterial, but I don't think I had either of those. I guess it's hard to say, but my issue resolved with treatment for thrush.

joes.mom, I found that info in BAMS interesting too. I don't think the point was that yeast infections never cause such symptoms, but rather that it is more rare than was once thought. This would be consitent with the fact thrush is overdiagnosed in general, which certainly does not mean some moms don;t have struggles with thrush.

Re: Help needed - nipple and breast pain

Originally Posted by @llli*lllmeg

joes.mom, I found that info in BAMS interesting too. I don't think the point was that yeast infections never cause such symptoms, but rather that it is more rare than was once thought. This would be consitent with the fact thrush is overdiagnosed in general, which certainly does not mean some moms don;t have struggles with thrush.

Yeah, it's interesting. I had deep burning and itching sensations in my breasts, so that seemed very consistent with thrush. I used fluconazole and nystatin, but for me, I felt that big doses of probiotics for me and baby, and even applying some externally to my breasts, is what did the trick. The nice thing about probiotics is that, if you don't have thrush, they're totally harmless. You can't really overdose on them, and there are no negative side effects. So when in doubt, I always recommend them. They may not cure you, but they can't hurt.

You can call me JoMo!

Mom to baby boy Joe, born 5/4/09 and breastfed for more than two and a half years, and baby girl Maggie, born 7/9/12.

Re: Help needed - nipple and breast pain

Thanks for the further suggestions!

I spoke with my doctor again yesterday and he was firm that he didnt think this was a bacterial infection that we had mis-diagnosed. He suggested waiting a couple of weeks to start a second course of the fluconazole as it is very strong. I may request a bacterial culture if things dont clear up soon though he didnt think we needed one. He also said that if the baby doesnt have symptoms of thrush (which she doesnt, and hasnt in the past) then there was not much point in using the nystatin when I am not taking the fluconazole.

On the new blister, I now think I will use a sterilized needle on it so it can drain soon. Will keep using the APNO to prevent infection (though it doesnt seem like the APNO helped prevent infection with the first blister) and use the nipple shield for temporary relief after nursing/ pumping. The pain is continuing post nursing so it may be that there is still an infection?

On the probiotics - would you recommend one in particular? Also, are these absoultely without any effects for the baby if it is recommended that I give her the probiotics too (or was your comment in terms of breastfeeding the baby while on probiotics?)

Re: Help needed - nipple and breast pain

Thank you again to Meg, Mommal and Jo Mo!

I used the nipple shield to protect the nipple from cloth abrasions when I was not nursing and it worked for a day or so. I discontinued that since milk was leaking from the breast fairly continuously (perhaps from the pressure of the shield against the skin) and things were getting messy. Overall my pain seems to be less but still there. Depending on the time of day and when baby has nursed last, the injured area looks more like its new skin or a whitish blister. I am hoping the probiotics will help heal from this point on if there is no infection. The doctor agreed we should try another antibiotic course in a couple o weeks if I wanted, if we see no change in the pain.

Meg - I didnt answer your thought - on nursing positions and latch, I use one of two positions - side lying and having her lying on the boppy while I am sitting. The side lying position is the only obe that worked initially when she was very small and I was trying to get her to start feeding after coming back from the hospital.
The LC has seen me when the blister had formed and didnt seem to think latch/ positioning was an issue but I will check with her again. The time when the blister first formed she was being moody with drinking ( we were still transitioning from fulltime formula) and I sometimes let her continue with a not so great latch if it seemed like she was drinking even though it was uncomfortable for me. I now realize that was not so smart in this context. Oh well.

Re: Help needed - nipple and breast pain

I've only just read this thread, accidentally, while looking for something else, but I'd very much like to encourage you to follow up with your doctor.

There is a clear pattern to the posts: you are getting accurate information here, but when the information is presented to your doctor, his responses are not helpful / confusing / just plain wrong.

Please find copies of LLL information sheets about thrush and mastitis (or print out the information from BAMS already shared here), and give it to your doctor. He doesn't sound particulary open to the facts, but there's always a chance, and you could be helping lots of other women avoid the struggles you've been having.

Hang in there - you are doing awesome and are clearly one deterimined momma!

Re: Help needed - nipple and breast pain

Thanks Ingrid! Since my last post I had upped the amount of APNO and was using wrm compresses before nursing for a few days and eventually things seemed to have healed fully. I have also become very diligent about cleaning nipples, pacifiers, and anything the baby has in her mouth.

Coincidentally, the blister came back yesterday. A couple of days back, I felt some shooting pains in the nipples and then saw the blister back yesterday. Since then, the breast pain after nursing has come back with a vengeance and I amm considering lancing the blister by myself. If there is an infection, I am going to request a secnd round of diflucam and instead of nystatin, lomotrin for the baby. Am hoping if I burst the blister the pain will go away suggesting there is no underlying infection. what do you think of my plan?
thanks!

Re: Help needed - nipple and breast pain

Landcng a blister sometimes does result in an immediate decrease in pain. But sometimes it stays painful for a while, because the broken skin is basically a very small crack, and cracks hurt until they heal.

If you decide to take care of this yourself, use a sterile needle and try to express milk frequently as you pick at the skin. Once you see milk bead up on the area, you've broken the blister.

Re: Help needed - nipple and breast pain

Thanks so much! The warm compresses and APNO helped a lot - the blister seems smaller now (and sometimes looks non- existent) and I also put some tissue soaked in olive oil for a few hours on the nipple on the first day of recurrence and that helped too. I am now waiting one more day for lancing the blister.
I have a question - I had assumed the pain will disappear if the blister goes but it sounds like that may take a few days more. Can it also be that when the whole breast hurts (as it does after nursing / pumping) that is only because of the blister and there is no underlying infection? I would take another round of diflucam if I needed to as I wouldnt want to leave an infection untreated. My baby seems to have taken a dislike to the breast now though and pulls away from it quite often (but not all the time). I am hoping this is because of the olive oil and APNO and will go away once I cease those.